Mosaic implants, kits and methods for correcting bone defects

ABSTRACT

A mosaic implant conformable to a curved surface, comprising first and second implant sections coupled along a beam portion extending across a length of the implant, each of the implant sections having
         a plurality of biocompatible mosaic plates, and   a plurality of wires which interconnect the plates with one another.
 
The mosaic implant is configured to be deformable such that at least a portion of the mosaic implant is conformable to a curved surface, with the beam portion providing structural support which resists inward deformation of the curved portion of the implant. A kit for forming a mosaic implant is also provided, along with a method for correcting a bone defect in a patient.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims priority to U.S. Provisional Patent Application Nos. 61/763,942, filed on Feb. 12, 2013, entitled “MOSAIC IMPLANTS, KITS AND METHODS FOR CORRECTING BONE DEFECTS,” and 61/802,228, filed on Mar. 15, 2013, entitled “MOSAIC IMPLANTS, KITS AND METHODS FOR CORRECTING BONE DEFECTS.” The entire disclosures of the foregoing provisional patent applications are incorporated by reference herein.

BACKGROUND

Bone tissue defects that cannot adequately heal via tissue regeneration often can be filled using autograph, allograph or synthetic scaffold materials. For large defects such as defects in the cranium or long bones, healing can be especially difficult. As a result, various scaffold strategies have been developed which utilize metal meshes or various porous ceramic materials which provide structural support for new tissue (e.g., bone). Many current strategies using metal mesh alone can be problematic due to low new bone formation and/or infections. Many currently used ceramic materials are mechanically weak and fragile, leading to a high risk of scaffold failure

One advantage of metal meshes is that they often can be shaped to closely fit the defect. Ceramic scaffolds, on the other hand, typically cannot be shaped after manufacturing and therefore have to be custom made in advance. In an attempt to overcome the problem of low bone in-growth with metal meshes, coating the mesh with hydroxylapatite powder has been proposed, particularly for use in revision surgery in joint replacement.

A more recent approach is described in PCT Pub. No. WO 2011/112145 A1, titled Implants and Methods for Correcting Tissue Defects, published Sep. 15, 2011. The foregoing published application is incorporated herein by way of reference, and is hereinafter referred to as “the '145 App.” The '145 App. describes mosaic implants which comprise a plurality of biocompatible mosaic plates which are connected by a wire (e.g., wire mesh) anchoring arrangement.

While a variety of devices and techniques may exist for correcting bone defects, it is believed that no one prior to the inventors has made or used an invention as described herein.

BRIEF DESCRIPTION OF THE DRAWINGS

While the specification concludes with claims which particularly point out and distinctly claim the invention, it is believed the present invention will be better understood from the following description of certain examples taken in conjunction with the accompanying drawings. In the drawings, like numerals represent like elements throughout the several views.

FIG. 1 depicts a top plan view of one embodiment of an implant section, as further described herein.

FIG. 2 depicts a top plan view of another embodiment of an implant section, with a portion of the mosaic tiles removed in order to show additional aspects of the wire mesh support frame, wherein the implant section of FIG. 2 has tapered sides such that the width of the implant section is widest at its center.

FIG. 3 depicts a top plan view of yet another embodiment of an implant section having further tapered sides compared to that of FIG. 2.

FIG. 4 shows an implant fabricated from the implant sections of FIGS. 1-3, simulating the implant secured to a patient's cranium over the area of a defect.

FIG. 5 depicts a cross-sectional view of the implant section of FIG. 3, taken along the line 5-5 thereof.

FIG. 6 is a top plan view of the wire mesh support frame of the implant section shown in FIG. 1.

FIG. 7 is a top plan view of the wire mesh support frame of the implant section shown in FIG. 2.

FIG. 8 is a top plan view of the wire mesh support frame of the implant section shown in FIG. 3.

FIG. 9 depicts an enlarged view of a portion of the wire mesh support frame of FIG. 6.

FIG. 10 shows an enlarged view of a portion of FIG. 4.

FIG. 11 depicts a perspective view of a mold suitable for forming the implant section of FIG. 3.

FIG. 12 depicts an enlarged view of a portion of FIG. 11.

FIG. 13 depicts a perspective view of a negative mold suitable for forming the mold of FIG. 11.

FIG. 14 depicts top plan views of three additional embodiments of implant sections having various configurations.

FIG. 15 depicts a portion of a further modified wire mesh support frame for use with any of the implant section embodiments described herein.

The drawings are not intended to be limiting in any way, and it is contemplated that various embodiments of the invention may be carried out in a variety of other ways, including those not necessarily depicted in the drawings. The accompanying drawings incorporated in and forming a part of the specification illustrate several aspects of the present invention, and together with the description serve to explain the principles of the invention; it being understood, however, that this invention is not limited to the precise arrangements shown.

DETAILED DESCRIPTION

The following description of certain examples should not be used to limit the scope of the present invention. Other features, aspects, and advantages of the versions disclosed herein will become apparent to those skilled in the art from the following description. As will be realized, the versions described herein are capable of other different and obvious aspects, all without departing from the invention. Accordingly, the drawings and descriptions should be regarded as illustrative in nature and not restrictive.

Examples described herein relate to implants for use in correcting various bone defects, such as implants for use in cranioplasty procedures. The implants generally include a plurality of biocompatible mosaic plates which are interconnected with one another by a plurality of wires extending between adjacent plates. Embodiments of the implants described herein also include retention features such as a plurality of eyelets located about the periphery of the implant through which fasteners (e.g., bone screws) may be driven into bone surrounding a defect.

In some instances, the implants are configured such that the implant may be cut to various sizes while still providing the retention features about the periphery of the implant. In this manner, an implant comprising a plurality of biocompatible mosaic plates interconnected with one another by a plurality of wires extending between adjacent plates is fabricated in a predetermined configuration which not specific to a defect in a particular patient. Thereafter, the implant is then sized and shaped (e.g., deformed into a curved shape) according to the needs of a particular patient. Some embodiments provide two or more implants in predetermined configurations (e.g., two or more different sizes) such that one of the implants may be selected for use in a particular patient, and then sized and shaped as necessary.

In some embodiments, an implant ready for implantation in a patient comprises a single section of interconnected mosaic plates. In other embodiments, an implant comprises two or more implant sections which are coupled to one another in order to form an implant. By way of example, two implant sections are coupled to one another along a beam portion which extends across a length of the implant. In one particular example, two implant sections are coupled to one another along adjacent sides such that the beam portion is provided by the coupled sides of the implant sections. In still further embodiments, a series of implant sections, which may be identical or different in size, shape and/or configuration, are coupled together so as to form a single implant for use in a patient.

Implants described herein, whether comprising a single implant section or a plurality of implant sections coupled to one another, are also deformable such that at least a portion of the implant is conformable to a curved surface (e.g., a spherical, spheroidal, cylindrical, etc. surface). In this manner, for example, the implant may be deformed such that the upper and lower surfaces of the mosaic plates will form a generally curviplanar surface (with small gaps between adjacent plates). The implant may be shaped at the time of fabrication (e.g., after molding of the mosaic plates) and/or at another time prior to implantation in a patient (e.g., in an operating room).

When deformed in this manner, either at the time of fabrication or by a medical practitioner in the operating room, some embodiments described herein include additional components and/or features which provide structural support to the curved portion of the implant so as to resist deformation of the curved portion following implantation in a patient (e.g., due to external mechanical loads). In other words, the curved surface of the implant will not flatten or cave inward in response to external mechanical loads. In some embodiments, the beam portion of coupled implant sections provides such structural support. Alternatively, or in addition thereto, one or more support girders may also be provided on one or more of the implant sections and/or across an implant in order to provide similar structural support. By providing such structural support, implants described herein may be used to treat large defects. Multiple implant sections may be coupled together in any of a variety of combinations so as to allow the implant to not only conform to the desired shape (in terms of size, curvature and perimetral shape), but also span defects of considerable size. By way of example only, cranial defects (e.g., regions where a patient's cranium is missing) up to about 200 mm×about 130 mm in size, with the missing portion of the cranium having a variety of curvatures, may be treated using the implants described herein.

As used herein, the term “wire” refers to a strand, rod, strut, or similar structure having a length that is relatively long compared to its width and thickness, regardless of cross-sectional shape. For example, a “wire,” as used herein, can have a circular, oval, rectangular, or other cross-sectional shape. In some of the embodiments described herein, some of the wires of the implants do not have a constant width and/or thickness along their entire length, and may have segments or regions which are irregular in shape. For example, some wires may have a pleated or crimped segment which allows the effective length of the wire to be elongated or shortened, while others have segments of reduced width and/or thickness to provide regions of greater flexibility. An individual wire may be in the form of a single, continuous structure, or a plurality of individual filaments or strands may be combined to form a wire (e.g., wrapped or braided).

The wires may be made from any of a variety of biocompatible materials suitable for implantation in a patient, such as various metals, polymers, or even composite materials of two or more metals and/or polymers. Non-limiting examples include biocompatible polymers such as polycaprolactone, shape memory alloys such as nitinol, titanium, titanium alloys (e.g. Ti₆Al₄V) and stainless steel. The wires may also be formed in any of a variety of manners such as forging, casting, molding, extrusion, cutting, etching, stamping, etc. In certain embodiments described further herein, the wires which interconnect the mosaic plates are formed from a metal sheet (e.g., titanium) which is stamped or cut (e.g., using an automated laser cutting device) in a predetermined pattern to produce a unitary mesh of connected wires having a wire rim extending about at least a portion of its periphery.

FIGS. 1-3 depict exemplary mosaic implant sections (10, 110, 210) which may be used either individually or in combination in the repair of bone and other tissue defects in mammals (including human patients). For example, two or more of mosaic implant sections (10, 110, 210), either identical sections or any combination of different sections, may be coupled together to provide a single implant. Any number of shapes and sizes of mosaic implant sections may be provided, and the three shown are merely exemplary of three possible configurations.

Whether used singly or in a combination of two or more implant sections coupled to one another, the resulting mosaic implant is conformable to various curved shapes in order to match that of a patient's bone defect. In one embodiment, by providing a plurality of differently shaped, sized and/or configured mosaic implant sections (10, 110, 210), such as in the form of a kit, two or more implant sections may be selected and coupled together to provide an implant which is sized and configured for a particular patient. For example, the resulting implant comprising two or more of mosaic implant sections (10, 110, 210) may be configured to match a particular patient's cranial defect in terms of size, shape (e.g., perimetral shape) and, in some instances, curvature. In other instances, a single implant section (10, 110, 210), optionally cut to size and shape as necessary, will be suitable for a relatively small defect in a patient. Larger defects can be treated with two or more implant sections (10, 110, 210) coupled together so as to provide an implant of a sufficient size for the patient's defect. As further described herein, some embodiments of coupled implant sections provide additional structural support and/or implants having a greater degree of curvature. Kits for such purposes are also described further herein.

By way of one specific example, FIG. 4 depicts an exemplary mosaic implant (400) implanted in a skull having a very large defect. In this illustration, a large portion of the skull is missing as the result of, for example, trauma. Mosaic implant (400) comprises five implant sections which have been coupled together along their adjacent sides. Specifically, implant (400) comprises, from left to right, an implant section (210), another implant section (210), an implant section (110), and two implant sections (10). Each of the implant sections also has been trimmed in length, as further described herein. In addition, the far right implant section (10) also has been trimmed in width. In this manner, implant (400) is sized and shaped to correspond to the patient's bone defect.

As also seen in FIG. 4, implant (400) is shaped so that it generally conforms to a curved surface corresponding to the typical shape of the missing portion of patient's cranium. In other words, implant (400) has been shaped (i.e., deformed) to match the patient's cranial shape. Such shaping not only helps to ensure the maintenance of sufficient cranial volume upon bone in-growth and implant resorption, but also provides a cosmetically pleasing appearance. In addition and as further described herein, implant sections (10, 110, 210) are configured and coupled together such that implant (400) has high mechanical strength which, following implantation in a patient, resists deformation due to external mechanical loads. Implant (400), for example, will resist flattening or caving-in due to mechanical loads or impact which might occur during normal daily activities. Without one or more of the structural support features described further herein, implant (400) would be more likely to collapse or bend inwardly as a result of an external force applied against the area of implant (400).

Implant (400) can be attached to host tissue (e.g., the patient's cranial bone about the perimeter of a defect) via sutures, plates, screws, clamps and/or any of a variety of other fasteners or fixation devices. In FIG. 4, implant (400) is attached to the surrounding cranial bone using a plurality of screws (e.g., titanium bone screws) inserted through retention eyelets (40, 140, 240) located along portions of the periphery of the implant sections (10, 110, 210), as described further herein.

Returning to FIGS. 1-3, each implant section (10, 110, 210) comprises a plurality of biocompatible mosaic plates (12, 112, 212) which are interconnected with one another by a plurality of wires (14, 114, 214). Each mosaic plate (12, 112, 212) is connected to a plurality of the immediately adjacent mosaic plates by the wires (14, 114, 214). In general, each plate (12, 112, 212) (or at least a majority of the plates of an implant section) is connected to two or more adjacent plates by the wires (14, 114, 214). In the particular examples shown in FIGS. 1-3, the mosaic plates located along the side, top and bottom edges of the implant section are connected to two or three adjacent plates. In contrast, the interior mosaic plates are connected to four of the six adjacent plates. Also in the embodiments shown, wires (14, 114, 214) extend between and into the adjacent connected plates (12, 112, 212).

As further described herein, the wires (14, 114, 214) may be configured such that separate, non-intersecting, non-connected wires extend between adjacent plates. In other embodiments, wires (14, 114, 214) comprise an arrangement of crossing wires which may or may not be connected to each other, as described in the '145 App. In yet another embodiment, and as shown in FIGS. 1-3 and described below, wires (14, 114, 214) are integrally formed with one another such as by cutting (e.g., laser cutting), etching or stamping a flat sheet in order to provide wires (14, 114, 214) in the form of wire segments connected to one another via retention eyelets (40, 140, 240) so as to provide wire mesh. As used herein, a “mesh” comprises an arrangement of wires wherein at least two crossing wires are joined at one, some, or all of their intersections, or wherein wire segments (e.g., wires (14, 114, 214) are joined to one another (e.g., via eyelets (40, 140, 240) such that open regions are located between and bounded by adjacent wires. In the embodiments shown in FIGS. 6-8, the open regions between and bounded by adjacent wires (14, 114, 214) have the shape of a parallelogram. It will be understood, however, that any of a variety of other mesh arrangements may be employed.

Biocompatible mosaic plates (12, 112, 212) can be composed of any of a variety of resorbable and/or stable (i.e., non-resorbable) biocompatible materials, including various types and/or combinations of polymers, ceramics and metals. In some embodiments, the plates are composed of an osteoconductive and/or osteoinductive material. Osteoconductive materials serve as a scaffold on which bone cells will attach, migrate, and grow and divide so as to form new bone on the surfaces of the plates (12, 112, 212). Osteoinductive materials induce new bone formation around the plates (12, 112, 212). In the embodiments described herein having the plates (12, 112, 212) arranged such that a gap is provided between adjacent plates, osteoconductive and/or osteoinductive mosaic plates will facilitate bone growth onto and between the plates of the implant (400), since the gaps allow for the free circulation of blood and tissue fluids between the plates.

In some embodiments, biocompatible mosaic plates (12, 112, 212) are composed of a moldable bioceramic or biopolymer material. While bioceramic materials can be produced by sintering ceramic powders, it can be difficult to produce complex shapes in this manner. Alternatively, bioceramics can be formed by a chemical bonding route whereby the ceramic material is formed by chemical reaction, such as a cement setting and hardening reaction.

In a particular embodiment, a hydraulic cement composition is used to mold mosaic plates (12, 112, 212). Non-limiting examples include cement precursor compositions comprising one or more Ca-salts such as calcium sulfates, calcium phosphates, calcium silicates, calcium carbonates and combinations thereof. As further described herein, the biocompatible plates are formed by molding the cement composition around portions of the wires (14, 114, 214). A powdered cement precursor composition is combined with either a non-aqueous water-miscible liquid or a mixture of water and a non-aqueous water-miscible liquid. The mixture is then poured or injected into a mold having the wires (14, 114, 214) positioned therein, and allowed to harden (e.g., in a water-containing bath) so as to form the mosaic plates (12, 112, 212) interconnected to one another by the plurality of wires (14, 114, 214).

Various cement compositions which may be used to mold mosaic plates (10, 110, 210) are described, for example, in U.S. Provisional Pat. App. No. 61/737,355, filed Dec. 14, 2012, titled “Cement-Forming Compositions, Cements, Implants and Methods for Correcting Bone Defects.” Alternative cement compositions for use in molding the plates, including storage stable premixed hydraulic cement compositions, are described in PCT App. No. PCT/IB2012/054701, filed Sep. 10, 2012, titled “Storage Stable Premixed Hydraulic Cement Compositions, Cements, Methods, and Articles.” Still further cement compositions which may be used to mold the plates (12, 112, 212) are described, for example, in the '145 App., as well as PCT App. No. PCT/IB2012/054228, filed Aug. 21, 2012, titled “Implants and Methods for Using the Implants to Fill Holes in Bone Tissue,” and PCT Pub. No. WO 2010/055483 A2, published May 20, 2010, titled “Hydraulic Cements, Methods and Products.” Each of the foregoing patent applications and publications is incorporated by reference herein.

In one embodiment, the compositions are calcium phosphate cement-forming compositions which comprise a monetite-forming calcium-based precursor powder and a non-aqueous water-miscible liquid.

In one specific embodiment, the monetite-forming calcium-based precursor powder comprises monocalcium phosphate (monocalcium phosphate monohydrate (MCPM) and/or anhydrous monocalcium phosphate (MCPA)) and β-tricalcium phosphate in a weight ratio of 40:60 to 60:40, and from 2 to 30 weight percent, based on the weight of the precursor powder, of dicalcium pyrophosphate powder (also referred to herein as calcium pyrophosphate). The powder to liquid (wt/vol) ratio in the composition is from 2 to 6 g/ml.

In another embodiment, the compositions are calcium phosphate cement-forming compositions which comprise a monetite-forming calcium-based precursor powder and are adapted to be mixed with an aqueous liquid or exposed to an aqueous liquid to achieve hardening. In one specific embodiment, the monetite-forming calcium-based precursor powder comprises monocalcium phosphate (monocalcium phosphate monohydrate (MCPM) and/or anhydrous monocalcium phosphate (MCPA)) and β-tricalcium phosphate in a weight ratio of 40:60 to 60:40, and from 2 to 30 weight percent, based on the weight of the precursor powder, of dicalcium pyrophosphate powder (also referred to herein as calcium pyrophosphate).

The molded plates (14, 114, 214) may thus comprise monetite and from 2 to 30 weight percent of dicalcium pyrophosphate. The monetite composition contains a majority of monetite, and in specific embodiments, contains at least 55 wt %, at least 60 wt %, at least 65 wt %, at least 70 wt %, at least 75 wt %, at least 80 wt %, at least 85 wt %, or at least 90 wt %, monetite. Such compositions results in slower implant resorption in a bone defect repair in a patient, as well as improved bone induction in a bone defect repair in a patient.

In additional embodiments, the monetite-forming calcium-based precursor powder comprises monocalcium phosphate and β-tricalcium phosphate mixed in a weight ratio of 45:55 to 52:48, and calcium pyrophosphate powder. In specific embodiments, the monocalcium phosphate (monocalcium phosphate monohydrate (MCPM) and/or anhydrous monocalcium phosphate (MCPA)) is acidic and has a pH of less than 6.0. In a more specific embodiment, a 0.1 g/ml saturated aqueous solution of the monocalcium phosphate has a pH less than 3.0. In a more specific embodiment, the MCPA and MCPM should exhibit a pH of 2.5-2.8. In one embodiment, the monocalcium phosphate (MCP) consists essentially of MCPA, whereby significant amounts of MCPM, i.e., greater than about 25%, or greater than about 10%, or greater than about 5%, based on the weight of the monocalcium phosphate, are excluded. In another embodiment, the monocalcium phosphate consists of MCPA. The MCPA does not contain any crystal water as is the case with mono calcium phosphate monohydrate.

In further embodiments, the calcium pyrophosphate (dicalcium pyrophosphate) comprises from 2 to 10 wt %, from 3 to 10 wt %, from 4 to 10 wt %, from 5 to 10 wt %, from 6 to 10 wt %, from 7 to 10 wt %, or from 8 to 10 wt %, of the precursor powder or the molded monetite composition. In further embodiments, the calcium pyrophosphate comprises from 2 to 5 wt %, from 3 to 5 wt %, or from 4 to 5 wt % of the precursor powder or the monetite composition.

In further embodiments, the calcium pyrophosphate comprises from 2 to 15 wt %, from 3 to 15 wt %, from 4 to 15 wt %, from 5 to 15 wt %, from 6 to 15 wt %, from 7% to 15 wt %, from 8 to 15 wt %, from 9 to 15 wt %, from 10 to 15 wt %, from 11 to 15 wt %, or from 12 to 15 wt %, of the precursor powder or the monetite composition. In further embodiments, the calcium pyrophosphate comprises from 2 to 20 wt %, from 3 to 20 wt %, from 4 to 20 wt %, from 5 to 20 wt %, from 6 to 20 wt %, from 7 to 20 wt %, from 8 to 20 wt %, from 9 to 20 wt %, from 10 to 20 wt %, from 11 to 20 wt %, from 12 to 20 wt %, or from 15 to 20 wt %, of the precursor powder or the monetite composition. In further embodiments, the calcium pyrophosphate comprises from 2 to 25 wt %, from 3 to 25 wt %, from 4 to 25 wt %, from 5 to 25 wt %, from 6 to 25 wt %, from 7 to 25 wt %, from 8 to 25 wt %, from 9 to 25 wt %, from 10 to 25 wt %, from 11 to 25 wt %, from 12 to 25 wt %, from 13 to 25 wt %, from 14 to 25 wt %, from 15 to 25 wt %, or from 20 to 25 wt %, of the precursor powder or the monetite composition. In further embodiments, the calcium pyrophosphate comprises from 3 to 30 wt %, from 4 to 30 wt %, from 5 to 30 wt %, from 6 to 30 wt %, from 7 to 30 wt %, from 8 to 30 wt %, from 9 to 30 wt %, from 10 to 30 wt %, from 11 to 30 wt %, from 12 to 30 wt %, from 13 to 30 wt %, from 14 to 30 wt %, from 15 to 30 wt %, from 16 to 30 wt %, from 17 to 30 wt %, from 18 to 30 wt %, from 19 to 30 wt %, from 20 to 30 wt %, from 21 to 30 wt %, from 22 to 30 wt %, from 23 to 30 wt %, from 24 to 30 wt %, or from 25 to 30 wt %, of the precursor powder or the monetite composition.

In any of the embodiments disclosed herein, the calcium pyrophosphate may comprise alpha-dicalcium pyrophosphate, beta-dicalcium pyrophosphate and/or gamma-calcium pyrophosphate. In specific embodiments, the calcium pyrophosphate comprises beta-dicalcium pyrophosphate. In other specific embodiments, the calcium pyrophosphate comprises alpha-dicalcium pyrophosphate. In other specific embodiments, the calcium pyrophosphate comprises gamma-dicalcium pyrophosphate.

The precursor powder composition may comprise one or more additional Ca-salts selected from the group consisting of anhydrous dicalcium phosphate, dicalcium phosphate dehydrate (brushite), octacalcium phosphate, α-tricalcium phosphate, alpha-dicalcium pyrophosphate, gammadicalcium pyrophosphate, amorphous calcium phosphate, calcium-deficient hydroxyapatite, non-stoichiometric hydroxyapatite, tetracalcium phosphate, β-TCP granules, and/or combinations thereof, in minor amounts which do not change the monetite-forming quality of the precursor powder.

The porosity of the molded plates (12, 112, 212) may also be controlled, as the porosity affects bone in-growth and the resorption time in vivo. For example, porosity may be controlled by controlling monocalcium phosphate particle size in the precursor composition, and/or adding one or more porogens to the precursor composition. In some embodiments, the molded plates have a porosity of from 40 to 50%, and in other embodiments the porosity is about 46%.

In one specific embodiment, a monetite-forming precursor composition is used, and comprises: (a) acidic (pH<6) monocalcium phosphate (monocalcium phosphate monohydrate (MCPM) and/or anhydrous monocalcium phosphate (MCPA)); (b) β-tricalcium phosphate; and (c) 2-30 wt. % dicalcium pyrophosphate powder (also referred to as calcium pyrophosphate), based on the total weight of the precursor powder. The weight ratio of monocalcium phosphate to β-tricalcium phosphate is between 40:60 and 60:40. It will also be understood that the monocalcium phosphate portion of the precursor composition may include a small amount of monetite (e.g., 8-12%, based on the weight of the precursor powder).

The above-described combination of calcium phosphates (e.g., in the form of a powder mixture) is then mixed with a non-aqueous water-miscible liquid such as glycerol at a powder to liquid (g/ml) ratio of from 2 to 6. The liquid portion optionally may include up to 20% water (based on the total liquid volume). After mixing, the precursor mixture is injected into a mold having the wires (14, 114, 214) positioned therein, with portions of each wire extending into and between the mold cavities which are shaped to form the mosaic plates (12, 112, 212). The filled mold is then exposed to water, such as by placing the mold in a water bath, and the cement is allowed to harden (e.g., 24 hours in a room temperature water bath). The implant section (10, 110, 210) is then removed from the mold. Further processing such as soaking the implant section in water to remove glycerol residues may be performed, as necessary.

The thus-formed mosaic plates (12, 112, 212) in the example described above will comprise monetite (CaHPO₄) and 2-30 wt. % dicalcium pyrophosphate, along with varying amounts of other materials such as β-tricalcium phosphate and minor amounts of brushite (CaHPO₄.2H₂O). The mosaic plates (12, 112, 212) in some embodiments comprise at least 65 wt %, at least 70%, at least 75%, at least 80%, at least 85%, or at least 90% monetite. As further discussed in U.S. Prov. Pat. Appl. 61/737,355, filed Dec. 14, 2012, the presence of dicalcium pyrophosphate not only delays resorption of the mosaic plates but also provides osteoinductivity (i.e., promotes new bone growth around and between the mosaic plates as compared to similar monetite formulations which do not include dicalcium pyrophosphate).

Each mosaic plate (12, 112, 212) may have any of a variety of shapes, such as triangles, circles, squares, rectangles, pentagons, hexagons, or other polygons. The shape of each plate may be regular (e.g., a pentagon or hexagon having sides of equal length) or irregular. The plates (12, 112, 212) of an implant section (10, 110, 210) may have the same or different shapes, regular and/or irregular. In some embodiments, the plates (12, 112, 212) have identical shapes (e.g., regular hexagons) and are arranged in a pattern such that each side edge of a plate is spaced apart from an edge of an immediately adjacent plate by the same (or nearly the same) amount so that a consistent gap is provided between adjacent plates. In other instances, there may be regions of the implant section (10, 110, 210) whereat the gap between adjacent plates is larger, for any of a variety of reasons (e.g., to accommodate a support structure). In the event that the mosaic plates of an implant section do not all have identical shapes, adjacent plates may nevertheless have complementary shapes such that the plates are arranged in a pattern with no overlap of plates and substantially equal gaps between adjacent plate edges.

In the specific embodiments shown in FIGS. 1-3, each implant section (10, 110, 210) includes both hexagonal (12A, 112A, 212A) and pentagonal plates (12B, 112B, 212B). The mosaic plates are arranged in five columns extending lengthwise along the length (L) of the implant section (10, 110, 210). The columns of plates are staggered such that consistent gaps are provided between the edges of adjacent plates, as shown. Thus, each column is shifted from an adjacent column in the lengthwise direction by slightly more than ½ the width of an individual plate.

The plates (12A, 112A, 212A) of the center three columns are in the shape of hexagons, each of approximately the same dimensions except for truncated plates (12C, 112C, 212C) located near the center of the implant section (10, 110, 210). Truncated plates (12C, 112C, 212C) are truncated along their edges adjacent a support girder (250) which extends across the width (W) of the implant sections (as discussed further herein). By truncating plates (12C, 112C, 212C), these plates do not cover support girder (250), thus allowing the implant section (10, 110, 210) to be deformed (curved) in the region of support girder (250) without fracturing plates (12C, 112C, 212C).

The plates (12B, 112B, 212B) in the outermost columns are in the shape of irregular pentagons. The outermost edges of plates (12B, 112B, 212B) (i.e., the edge adjacent the right and left sides of the implant sections) are aligned with one another in a linear (FIG. 1) or curvilinear (FIGS. 2 and 3) fashion. As described further herein, a wire rim (30, 130, 230) extends about the entire periphery of the implant section (10, 110, 210), and is connected to plates (12B, 112B, 212B) as well as support girder (50, 150, 250) via wire struts (32, 132, 232) which extend between the rim (30, 130, 230) and outer plates (12B, 112B, 212B) (as well as between the rim and the ends of the support girders). The outermost edges of pentagonal outer plates (12B, 112B, 212B) are aligned with, and spaced inwardly from, wire rim (30, 130, 230), as shown in FIGS. 1-3. In alternative embodiments, the wire rim (30, 130, 230) may extend about only a portion of the periphery of the implant section, such as along either side thereof.

On implant section (10), the right and left sides of rim (30), and hence the right and left sides of the implant section (10) are parallel such that implant section (10) has a rectangular shape. For implant sections (110, 210), on the other hand, the right and left sides of rim (130, 230) are curvilinear such that the implant section (110, 210) has the shape of a curved rectangle—the right and left sides are symmetrically curved, while the top and bottom ends are parallel. As a result implant sections (110, 210) are widest at their center (i.e., where support girder (150, 250) is joined to rim (130, 230), and symmetrically taper in width towards each end.

In alternative embodiments, the sides of an implant section may be linearly tapered rather than curvilinearly tapered. In such embodiments, are still widest at their center, but symmetrically taper in width towards each end along straight lines. As yet another alternative, only one side of an implant section may taper (linearly or curvilinearly). In still another alternative embodiment, one or both sides of an implant section may be tapered along only a portion of its length. For example, the sides of an implant section may taper in width from support girder (50, 150, 250) towards only the top or bottom ends.

Implant section (210) differs from implant section (110) in that implant section (210) is wider at support girder (250). In other words, the right and left sides of rim (230) of implant section (210) are more curved than the right and left sides of rim (130) of implant section (110). Additionally, in the depicted embodiments, implant sections (10, 110, 210) all have substantially the same width at their top and bottom ends. As will be discussed further herein, the varying configurations of implant sections (10, 110, 210) allow the implant sections to be coupled in a variety of arrangements in order to provide an implant (400) of a variety of different curvatures. Thus, any number of implant sections of additional shapes and configurations may be provided (e.g., one with sides having even greater curvature than implant section (210)) so as to enable additional combinations of implant sections for matching various bone defects.

Implant sections (10, 110, 210) may be provided in any of a variety of sizes. In the particular example shown, implant section (10) has a width W of about 39 mm and a length L of about 150 mm. Implant section (110) has a width of about 45 mm at its center (i.e., at support girder (150)) and 37 mm at the top and bottom ends, and a length of about 148 mm. Implant section (210) has a width of about 50 mm at its center (i.e., at support girder (150)) and 35 mm at the top and bottom ends, and a length of about 148 mm. Of course these sizes are merely exemplary, as any of a wide variety of sizes and curvatures/tapers may be provided in the implant sections.

Mosaic plates (12, 112, 212) may be provided in any of a variety of sizes. By way of example only, mosaic plates (12A, 112A, 212A) shown in FIGS. 1-3 have a width (W_(T)) of approximately 8 mm at their bottom surface and approximately 8.4 mm at their top surface, wherein the plate width is defined as the distance between opposite, parallel sides of a plate. Thus, the sidewalls of the mosaic plates (12A, 112A, 212A) are sloped or tapered such that the plates are wider at their top surface than at their bottom surface (e.g., as depicted in FIG. 5). The thickness of mosaic plates (12A, 112A, 212A) is approximately 4 mm (as depicted by distance T_(T) in FIG. 5). In addition, the gap between adjacent edges of plates (12, 112, 212) at the bottom surface of the plates is approximately 1 mm, and approximately 0.6 mm at the top surface. For implant section (210), on the other hand, the mosaic plates (212A), particularly those of the first and third columns, have varying sizes such that the plates (212A) at the ends of the implant section have a width of approximately 7.5 mm at their bottom surface and approximately 7.9 mm at their top surface. The plates (212A) at the middle of implant section (210) have a width of approximately 8.7 mm at their bottom surface and approximately 9.1 mm at their top surface. Of course these dimensions are merely exemplary of one embodiment, as any of a variety of plate sizes and spacings may be used.

As also seen in the cross-sectional view of FIG. 5, the sidewalls of the mosaic plates may be sloped or tapered such that the plates are wider at their top surface than at their bottom surface. Alternatively, this sloping or tapering may be configured in a variety of other manners, such as tapering the sidewalls of the mosaic plates from both the top and bottom surfaces so that the plates are widest in cross-section across the center of the plate, or at some other location between the top and bottom surfaces. The sloping or tapering of the sidewalls allows the implant section to be deformed into various curvatures, with a deeper concavity in the bottom surface of the implant without the edges of adjacent mosaic plates coming into contact with each other than would be possible with vertical, non-tapered sidewalls.

In still other embodiments, the top surface width W_(T) of each plate is between 2 and 20 mm, between 3 and 15 mm, or between 4 and 10 mm. In further embodiments, the mosaic plates have a thickness T_(T) which is between 10% and 150% of W_(T), between 20% and 80% of W_(T), or between 30% and 60% of W_(T). In order to obtain good aesthetical results, the thickness T_(T) is as small as possible while maintaining sufficient strength of the plates. In adjusting an implant to a specific defect the thickness T_(T) can be reduced by polishing or other material removal process, particularly along the periphery of the implant in order to improve implant fit and improve aesthetics (e.g., to provide a smooth, reduced height transition between the surface of surrounding bone and the upper surface of the implant).

In further embodiments, the gap between adjacent edges of plates at the bottom surface of the plates is less than 3 mm, less than 2 mm, or less than 1.2 mm. A smaller gap facilitates the filling of the gap by new bone growth. On the other hand, a smaller gap will inhibit the amount of deformation (i.e., curvature) which is possible when matching the implant to a patient's defect. In other words, having a larger gap allows the implant to be deformed more before adjacent plates contact each other, but larger gaps between plates also take a longer time to fill with new bone growth. It is of course possible to have different sized gaps between cavities if the implant is intended to have regions which will be substantially flat and other regions which will be deformed into various curvatures and shapes.

As mentioned previously, wire rim (30, 130, 230) which extends about the periphery of implant sections (10, 110, 210) is connected to plates (12B, 112B, 212B) as well as support girder (50, 150, 250) via wire struts (32, 132, 232). In addition, mosaic plates (12, 112, 212) are interconnected with one another by a plurality of wires (14, 114, 214) which extend between adjacent plates. In the embodiments shown, a single wire extends between each connected pair of adjacent plates. In other embodiments, two or more wires may extend between each connected pair of adjacent plates, as shown and described in the '145 App. Wires (14, 114, 214) may comprise separate, non-intersecting, non-connected wires which extend between and into adjacent plates—i.e., as individual wire segments. Alternatively, wires (14, 114, 214) may comprise crossing wires which may or may not be connected to each other, as described in the '145 App. In such arrangements, each wire may extend from one side or end of the implant section to the opposite side or end, such that each wire interconnects multiple pairs of adjacent plates.

In the embodiment shown in FIGS. 1-7, wires (14, 114, 214) are interconnected with one another via retention eyelets (40, 140, 240), some of which are also connected to rim (30, 130, 230) by wire struts (32, 132, 232). The resulting structure is a wire mesh support frame (20, 120, 220) which is bounded about at least a portion of its periphery by rim (30, 130, 230), as shown in FIGS. 6-8. Support frame (20, 120, 220) may be formed in a variety of ways such as by welding wire segments and eyelets to one another in the arrangement shown, or by a molding process. In the embodiments shown in FIGS. 6-8, the components of support frames (20, 120, 220) are integrally formed with one another by cutting (e.g., laser cutting), etching or stamping a flat sheet to form wires (14, 114, 214), eyelets (40, 140, 240), wire struts (32, 132, 232), support girder (50, 150, 250) and rim (30, 130, 230) from a single sheet of material. Any of a variety of materials may be used for support frames (20, 120, 220), such as biocompatible metals, including alloys. In the embodiments shown, support frames (20, 120, 220) are laser cut, using an automated, programmable laser cutting device, from a sheet of titanium. The titanium sheet comprises grade 2, 4 or 5 titanium, 0.3-0.6 mm thick. In the embodiment shown, grade 2 titanium, 0.4 mm thick is used. Alternatively, support frame (20, 120, 220) may be cut, etched, stamped, molded or otherwise formed from a biodegradable polymer such as polycaprolactone.

It should be noted that, as used herein, the term “eyelet” means an opening having a substantially closed perimeter, but it is not limited to a particular shape. Thus, eyelets (40, 140, 240) can be round, square, rectangular, trapezoidal, hexagonal, tear-drop, oval, elliptical or any other suitable shape. Of course other types of attachment apertures or other fastening points may be used in place of, or in addition to the eyelets (40, 140, 240).

In the particular embodiments shown in FIGS. 1-3, each mosaic plate (12, 112, 212) is connected to a plurality of the immediately adjacent mosaic plates by the wires (14, 114, 214). Except for those located along the top and bottom ends of the implant section, the interior plates (12A, 112A, 212A) of the center three columns of plates are connected to four of the six adjacent plates. The plates (12A, 112A, 212A) of the center three columns located along the top and bottom ends are connected to three of the five adjacent plates. Similarly, except for those located along the top and bottom ends of the implant section, the plates (12B, 112B, 212B) in the outermost columns are connected to three of four adjacent plates. Finally, the plates (12B, 112B, 212B) of the outermost columns located along the top and bottom ends are connected to two of the three adjacent plates.

Each eyelet (40, 140, 240) is positioned so as to be located entirely within the interior of a plate (12, 112, 212), such as approximately in the middle of the plate. In order to provide sufficient strength while also allowing the implant sections to be deformed (i.e., bent, particularly into various curvatures), wires (14, 114, 214) extend away from eyelets (40, 140, 240) so as to span between the adjacent, parallel sides of adjacent plates. Thus, wires (14, 114, 214) intersect the sides of the plates at an angle of approximately 90°, as best seen in FIG. 9.

In the particular arrangements of plates shown in FIGS. 1-9, vertical wires (14A, 114A, 214A) extend approximately parallel to the sides of the implant sections, in five straight or slightly curved columns. In implant section (10), wires (14A) extend in five parallel columns which are also parallel to the left and right sides of implant section (10). In implant sections (110, 210), the center column of wires (114A, 214A) extend parallel to the left and right sides of implant section (110, 210), while the other columns of wires (114A, 214A) are slightly curved to approximately match the curved sides of these implant sections (110, 210), the outermost columns of wires (114A, 214A) are slightly more curved than the columns spaced inwardly therefrom, but slightly less than the curvature of rim (130, 230) along the right and left sides of the implant sections (110, 210). Thus, wire struts (132, 232) of implant sections (110, 210) increase slightly in length progressing from the top and bottom ends towards support girder (150, 250).

The wires (14B, 114B, 214B) are arranged in a zigzag fashion across the width of the implant section (10, 110, 210), as shown. Thus, each wire (14B, 114B, 214B) extends from an eyelet (40, 140, 240) at an included angle of about 60° to one adjacent wire (14A, 114A, 214A) extending from the same eyelet, and at an included angle of about 120° to the other adjacent wire (14A, 114A, 214A) extending from the same eyelet. Each eyelet (40, 140, 240) therefore has four wires extending therefrom, either in the form of wires (14, 114, 214) or wires (14, 114, 214) in combination with wire struts (32, 132, 232).

When the support frame (20, 120, 220) is fabricated from a single sheet of metal, the wires (14, 114, 214), struts (32, 132, 232), eyelets (40, 140, 240), and rim (30, 130, 230) will generally have the same thickness. In the examples shown, the support frame members have a thickness of about 0.4 mm. The rim (30, 130, 230) has a width of 0.4 to 1.6 mm, or from 0.6 to 1.2 mm, or 1.0 to 1.2 mm. Wires (14, 114, 214) have a width of 0.4 to 0.6 mm, wire struts (32, 132, 232) have a width of about 0.45 mm, the interior diameter of eyelets (40, 140, 240) is approximately 2.1 mm, and the width of the metal forming the eyelets is about 0.4 mm.

In order to provide additional shapability to implant sections (10, 110, 210) and an assembled implant (400), the wires (14, 114, 214) include deformation zones. The deformation zones are generally located in the middle of the length of a wire (14, 114, 214) such that they will generally be positioned between adjacent plates so that deformation will occur between the plates so as to prevent cracking of the plates upon deformation of the implant section.

In the embodiments shown, wires (14, 114, 214) include two different types of deformation zones. Wires (14A, 114A, 214A) have reduced-width regions (15A, 115A, 215A) which are located between adjacent plates following molding. When the implant section is longitudinally deformed (i.e., curved about an axis which extends transverse to length L, as indicated by D_(LONG) in FIG. 4), wires (14A, 114A, 214A) will deform (i.e., bend) at reduced-width regions (15A, 115A, 215A) so that such deformation is less likely to cause the plates to crack. By way of one example, when wires (14A, 114A, 214A) have a width of 0.5 to 0.7 mm, reduced-width regions (15A, 115A, 215A) have a width of 0.3 to 0.5 mm. It should be understood that “transverse” is not intended to mean at an angle of 90 degrees.

Also in the embodiments shown, wires (14B, 114B, 214B) have pleated regions (15B, 115B, 215B) which are also located between adjacent plates following molding. Pleated regions (15B, 115B, 215B) not only have a reduced width, they also include one or more pleats which allow additional deformation of the implant while avoiding cracking the plates. In particular, pleated regions (15B, 115B, 215B) facilitate lateral deformation of the implant section (i.e., curving the implant section about an axis which extends transverse to width W, as indicated by D_(LAT) in FIG. 4). Wires (14B, 114B, 214B) will deform (i.e., bend) at pleated regions (15B 115B, 215B) rather than within the plates in order to avoid plate cracking. In addition, pleated regions (15B 115B, 215B) also allow the implant section to be locally stretched or compressed at pleated regions (15B 115B, 215B) in order to further facilitate shaping of the implant to match a patient's defect. In some instances, pleated regions (15B 115B, 215B) also allow for some adjustment of the retention eyelets (40, 140, 240) located along the top and bottom edges of the implant so as to properly locate these eyelets with respect to the bone surrounding a defect. In this manner, the eyelets can be repositioned somewhat to ensure that a screw or other fastener driven therethrough in to the surrounding bone will have sufficient purchase.

It should also be pointed out that although rim (30, 130, 230) generally can only be deformed along its length, struts (32, 132, 232) are deformable along their length. Thus, when an implant section is laterally deformed (as indicated by D_(LAT) in FIG. 4), struts (32, 132, 232), portions of which are not located within the plates, will deform along their lengths in order to further facilitate matching the implant to a desired curvature. Support girder (50, 150, 250) is deformable in a similar fashion.

When two or implant sections (10, 110, 210) are needed in order to provide an implant (400) corresponding to the shape of a patient's defect, two or more implant sections may be coupled to one another along portions of their rims (30, 130, 230). Such coupling may be accomplished in any or variety of ways, such as using mechanical fasteners, biocompatible adhesives, welding, binding, etc. In the embodiments shown in FIGS. 4 and 10, the implant sections are coupled to one another by spot welding. Thus, the rims (30, 130, 230) extending along the sides of adjacent implant sections (10, 110, 210) are positioned in overlapping arrangement and then welded to one another at spot welds (431) along the length of the overlapping rims.

While the deformation of an implant section in either the D_(LONG) or D_(LAT) directions is limited only by the spacing between adjacent plates and the amount of sidewall tapering of the plates, deformation in both the D_(LONG) and D_(LAT) directions is much more limited unless plates are removed. This is a result of the fact that spheres, spheroids and other similarly curved surfaces are not developable. (A “developable surface” is one that that can be flattened onto a plane without the need for any stretching or compression.) One advantage of implant sections (110, 210) which have curved rims (130, 230) along their sides is that the implant sections may be attached to one another (or to implant section (10)) along with adjacent sides to provide a shape which more closely matches a non-developable curved surface, much that way that various map projections are used to approximate the curvature of the earth in a flat plane. Thus, when the rim (130) of an implant section (110) is coupled along its length to the rim (230) of an implant section (210), the implant section will be, and in fact must be, deformed in both the D_(LONG) and D_(LAT) directions, as seen in FIG. 4. Most of the curvature in the D_(LAT) direction will result from deformation (i.e., bending of the struts (132, 232)), but this still allows implant (400) to be deformed so that the implant (400) is more conformable to a curved surface such as a sphere or spheroid or similar shapes corresponding to various regions of a cranium.

In addition, when rims (30, 130, 230) of implant sections (10, 110, 210) are coupled to one another, particular when done in an overlapping fashion, the rims of adjacent implant sections provide a beam portion extends across the length of the implant. This beam portion provides additional structural support to the curved implant (400) which resists deformation (e.g., flattening of the curved shape) following implantation in a patient. Similarly, support girder (50, 150, 250) also provides additional structural support across the central region of implant (400), often the most vulnerable area in terms of inward deformation (i.e., flattening or caving-in).

It will be understood that additional structural supports may be provided such as additional support girders extending across the width of an implant section. Similarly, the beam portion extending across a length of the implant may be provided in various alternative ways besides adjoining rims extending along the sides of coupled implant sections. For example, rim (30, 130, 230) itself provides structural support which resists inward deformation of a single implant section (10, 110, 210) which is implanted in a patient. Alternatively, one or more support girders similar to support girder (50, 150, 250) may be provided in the lengthwise direction, particularly in an arrangement wherein the support girder(s) is positioned in a zigzag arrangement between adjacent plates. Of course additional support girders extending across the implant sections may also be provided at various desired locations. As yet another alternative, a separate support girder may be provided, with implant sections coupled to the support girder along either side thereof.

As mentioned previously, implant sections (10, 110, 210) may be formed by a variety of processes, such as molding. In the specific embodiments shown, implant sections (10, 110, 210) are formed by molding plates (12, 112, 212) about the wires (14, 114, 214) of a support frame (20, 120, 220). One such mold (510) is shown in FIGS. 11 and 12, wherein the mold (510) is configured for use in forming implant section (210). Mold (510) may be formed of any of a variety of materials such as silicone, Teflon, other polymers or metals. Mold (510) includes a plurality of cavities (512) shaped and arranged for forming mosaic plates (212). Thus, cavities (512) have tapered sidewalls corresponding to the tapered sidewalls of the plates, as shown in FIG. 5. The bottom (513) of each cavity (512) corresponds to the bottom surface of a plate (212).

Channels (514) are provided in the sidewalls of selected cavities (513). Cavities (514) correspond to the locations of wires (214) of support frame (220) and have depth corresponding to the desired depth of the wires (214) in the implant section (210). Thus, channels (514) receive wires (214) therein. Circular cutouts (540) are also provided at the top and bottom ends of the mold to accommodate the eyelets (240) of support frame (220) which are not to be enclosed by plates (212), along with elongate grooves (541) which extend from cutouts (540) to the adjacent cavities (512). Elongate grooves (541) accommodate the wires (214) which extend away from eyelets (240). Similar, groove (550) extends across the width of the mold (510) for accommodating support girder (250) therein.

Prior to molding, a support frame (220) is positioned within mold (510) such that rim (230) extends about outer wall (515) of the mold cavities (512), with wires (214) positioned at the bottom of channels (514) and eyelets positioned within cutouts (540). The positioning of the wires (214) of support frame (220) is controlled by the depth of cutouts (540). Next, the precursor cement composition described previously (or other moldable composition) is inserted into the mold cavities (512) such as by pouring or injecting. While mold (510) does not require a top plate, other embodiments of mold (510) may include a top plate for enclosing the mold either before or after addition of the precursor composition. If the mold is sealed prior to the addition of the cement composition, the mold will include one or more sprues through which the cement may be injected into the mold cavities.

After setting and hardening of the mosaic plate material, the implant section (210) is removed from mold (510). Thereafter, the implant section (210) is cut to the desired length and width, as necessary. For example, as best seen in FIGS. 4 and 10, the portion of the rim (30, 130, 230) extending across the top and bottom ends of the implant section is cut off along with portions of the rim extending along the sides of the implant section as necessary. In addition, wires (14, 114, 214), particularly longitudinally extending wires (14A, 114A, 214A), may be cut as necessary, to trim the implant section to the desired length. Similarly, selected ones of laterally extending wires (14B, 114B, 214B) may be cut as necessary, particularly to trim in implant section to the desired width, as seen on the far right side of FIG. 4. Since eyelets (40, 140, 240) are used to secure the implant to bone surrounding a defect, the mosaic plate material along the periphery of the implant is also removed such as by breaking the plates off of the support frame using pliers or other suitable implement in order to expose one or more of the eyelets about the periphery of the implant (400), as also seen in FIG. 4.

As also seen in FIGS. 4 and 10, during molding some cement will set and harden within channels (514), directly above the portions of wires (14, 114, 214) and struts (32, 132, 232) not located within plates (12, 112, 212). Such excess cement (17, 117, 217) is not depicted in FIGS. 1-3. When the implant section is deformed to a curved shape (i.e., after molding, and in some cases within an operating room), these portions of excess cement (17, 117, 217) will fracture rather than the plates (provided the implant section is not deformed too much).

As mentioned previously, mold (510) comprises silicone or other moldable material. FIG. 13 depicts a negative mold (610) which may be used to form mold (510) by a molding process.

FIG. 14 depicts top plan views of three additional embodiments of implant sections having various configurations. The implant section of FIG. 14A is similar to implant section (110), however only three columns of mosaic plates are provided and one side of the wire mesh support frame has been omitted such that no rim is provided along that side of the implant. Instead, the rimless side of the implant includes a plurality of the retention eyelets. Effectively, wire mesh support frame (120) has been cut between the fourth and fifth columns of retention eyelets. This provides a narrower implant section suitable for use along an edge of a defect, as the eyelets may be used to secure the implant section in place. The implant section of FIG. 14B is similar to implant section (210), but considerably shorter with no rim along the ends of the implant section—only retention eyelets. Finally, the implant section of FIG. 14C is similar to that of FIG. 14A, only considerably shorter and with no rim extending along the ends or one side of the implant section. These various alternative shapes and configurations reduce waste as less material (particular the cement material) will be discarded, and are particularly suitable for use along an edge of a defect. By way of example only, these implant sections shown in FIG. 14 together with those previously described may have width of about 20 to about 60 mm, and lengths of about 60 to about 200 mm, as well as varying amounts of curvature or even irregular shapes. For example, instead of the opposing sides of the implant section having minor image, gentle curvatures, the opposing sides may be the same direction of curvature, along with a greater degree of curvature (e.g., a curved implant section having a constant width rather than the width tapering towards the ends as shown, for example, in FIG. 3). The curvature may even vary along the length of the implant section.

FIG. 15 depicts a portion of a further modified wire mesh support frame for use with any of the implant section embodiments described herein. In this embodiment, wire rim (330) includes a plurality of enlarged or widened regions (231) along its length. These enlarged regions facilitate spot welding and my be incorporated into any of the previously described implant section embodiments.

While several devices and components thereof have been discussed in detail above, it should be understood that the components, features, configurations, and methods of using the devices discussed are not limited to the contexts provided above. In particular, components, features, configurations, and methods of use described in the context of one of the devices may be incorporated into any of the other devices. Furthermore, not limited to the further description provided below, additional and alternative suitable components, features, configurations, and methods of using the devices, as well as various ways in which the teachings herein may be combined and interchanged, will be apparent to those of ordinary skill in the art in view of the teachings herein.

Having shown and described various versions in the present disclosure, further adaptations of the methods and systems described herein may be accomplished by appropriate modifications by one of ordinary skill in the art without departing from the scope of the present invention. Several of such potential modifications have been mentioned, and others will be apparent to those skilled in the art. For instance, the examples, versions, geometrics, materials, dimensions, ratios, steps, and the like discussed above are illustrative and are not required. 

What is claimed is:
 1. A mosaic implant conformable to a curved surface, comprising first and second implant sections coupled along a beam portion extending across a length of the implant, each of said first and second implant sections having a plurality of biocompatible mosaic plates, wherein said biocompatible mosaic plates comprise a hydraulic cement composition, and a plurality of wires which interconnect the plates with one another, wherein the mosaic implant is configured to be deformable such that at least one portion of the mosaic implant is conformable to a curved surface, and further wherein said beam portion provides structural support which resists inward deformation of said at least one portion of the implant.
 2. The mosaic implant of claim 1, wherein the mosaic implant is configured to be deformable both along the length of the beam portion and in a second direction which is transverse to the length of the beam portion.
 3. The mosaic implant of claim 2 wherein said beam portion is integral with at least one of said first and second implant sections.
 4. The mosaic implant of claim 3, wherein said beam portion comprises at least one wire rim which extends along a side of the implant section located adjacent the other implant section.
 5. The mosaic implant of claim 1 further comprising a support girder extending across at least a portion of one of said implant sections.
 6. The mosaic implant of claim 5, comprising a plurality of support girders spaced from each other.
 7. The mosaic implant of claim 1, wherein at least a portion of the mosaic implant is deformable to a substantially spheroidal surface.
 8. The mosaic implant of claim 1, wherein said first and second implant sections have different geometrical shapes.
 9. The mosaic implant of claim 8, wherein at least one of the implant sections has a tapered width along at least a portion of its length.
 10. The mosaic implant of claim 1, wherein said plurality of wires of said first and second implant sections comprise wire mesh.
 11. The mosaic implant of claim 10 wherein said wire mesh includes deformation zones located between adjacent mosaic plates which facilitate deformation of the mosaic implant so as to conform at least a portion of the implant to a curved surface.
 12. The mosaic implant of claim 10, wherein said wire mesh comprises a plurality of wire segments and a plurality of eyelets, wherein the wire segments are connected to each other by said eyelets.
 13. The mosaic implant of claim 12, wherein a portion of said plurality of eyelets are located along the periphery of the implant and are adapted to receive a fastener for securing the implant within a patient, with the remainder of the eyelets enclosed within said plates.
 14. The mosaic implant of claim 12, wherein each of said implant sections includes a support frame comprising said wire mesh and a wire rim which extends along at least one side of the implant section, and further wherein the implant sections are attached to one another along adjoining rims such that said beam section is provided by the attached rims of the implant sections.
 15. The mosaic implant of claim 1, further comprising a third implant section coupled to the second implant section along a second beam portion extending across a length of the implant, said third implant section comprising a plurality of biocompatible mosaic plates and a plurality of wires which interconnect the plates with one another.
 16. The mosaic implant of claim 1, wherein said implant sections include a plurality of fastening points which facilitate attachment of the mosaic implant in a patient.
 17. The mosaic implant of claim 1, wherein said biocompatible mosaic plates comprise a cement comprising at least 55 wt. % monetite.
 18. A kit for forming a mosaic implant, comprising a plurality of implant sections, each of said implant sections comprising a plurality of biocompatible mosaic plates, wherein said biocompatible mosaic plates comprise a hydraulic cement composition, and a plurality of wires which interconnect the plates with one another wherein pairs of said implant sections are configured for attachment to one another along or to a beam portion extending across a length of the assembled implant, further wherein the assembled mosaic implant is deformable such that at least one portion of the mosaic implant is conformable to a curved surface, with said beam portion providing structural support which resists inward deformation of said at least one portion of the implant.
 19. The kit of claim 18, wherein said plurality of wires of said implant sections comprise wire mesh, and further wherein said wire mesh includes deformation zones located between adjacent mosaic plates which facilitate deformation of the mosaic implant so as to conform at least a portion of the assembled implant to a curved surface.
 20. The kit of claim 18, wherein each of said implant sections includes at least one wire rim which extends along a side of the implant section, said implant sections attachable to one another along their respective rims such that said beam section is provided by the attached rims of adjacent implant sections of the assembled implant.
 21. A method for correcting a bone defect in a patient, comprising: (a) providing a mosaic implant comprising first and second implant sections coupled along a beam portion extending across a length of the implant, each of said first and second implant sections having a plurality of biocompatible mosaic plates, wherein said biocompatible mosaic plates comprise a hydraulic cement composition, and a plurality of wires which interconnect the plates with one another; (b) deforming the mosaic implant to a shape corresponding to a desired shape for the patient's bone defect such that at least one portion of the mosaic implant conforms to a curved surface; (c) positioning the implant at the site of the bone defect in the patient; and (d) securing the implant in place; wherein the beam portion of the implant provides structural support which resists inward deformation of said at least one portion of the implant. 